Here’s what you need to know about medical costs once the public health emergency ends | Milwaukee Neighborhood News Service
Devin Blake
February 21, 2023
The nationwide public health emergency, or PHE, is scheduled to end on May 11, bringing with it several changes to state and federal resources.
The PHE provided a key resource specific to fighting COVID-19 known as “medical countermeasures.” This included tests, vaccines and treatments.
When and how changes take place to the accessibility of these depends largely on one’s insurance status as well as the state you live in and your age.
Here are some things to keep in mind.
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The changes to testing accessibility will likely have the most resounding public health effect out of any post-PHE change, according to a policy brief published by The Henry J. Kaiser Family Foundation, or KFF. This will most likely have “broad implications for the people’s ability to get timely COVID diagnoses or prevent transmission.” KFF is a nonprofit organization that conducts health care research and provides health policy analysis.
The federal government purchased over-the-counter tests as well as vaccines and treatments, and “as long as the federal supply is available, you cannot be charged for them,” said Jennifer Kates, senior vice president at KFF. “When those supplies are up is when challenges will start to arise.”
Some of these resources made available by the PHE will not end on May 11, but “the clock will start ticking,” Kates added.
For those who have Medicaid, over-the-counter tests and polymerase chain reaction (PCR) tests, which are ordered by health care professionals, will be free until September 2024, said Kates.
After that point, coverage of over-the-counter tests will vary by state for Medicaid recipients, who also may face some cost-sharing for PCR tests.
Although ultimately decided by individual insurance companies, it is expected those with private insurance coverage, including people with private Medicare plans, will have to cover some portion of the cost associated with over-the-counter tests after the federal supply is depleted, according to the KFF brief. Those who are uninsured will have to pay the full costs of any over-the-counter tests or PCR test they purchase.
When the federal supply of vaccines has run out, they will remain free for most with some form of insurance.
They will also remain free for anyone 18 years old or younger who is under- or uninsured, Medicaid-eligible, American Indian or Alaska native through the Vaccines For Children program, or VFC. The program allows any child to get a U.S. Centers for Disease Control and Prevention-recommended vaccine for free.
Adults who are uninsured will have to pay out of pocket for vaccines once the federal supply runs out, Kates said.
The changes to vaccine accessibility do not apply to doses purchased by the U.S. Food and Drug Administration, though, as these are governed by a different emergency declaration.
As with vaccines and over-the-counter tests, treatments for COVID-19, such as nirmatrelvir and ritonavir, will remain free for everyone as long as the supply purchased by the federal government is still available. Once that supply is gone, those with Medicaid will continue to have free access until September 2024, then people may face some cost-sharing, said Kates.
Most with private insurance have already begun paying for COVID-19 treatments and will continue to do so after the end of the PHE. Those who are uninsured will likely have to pay full price for treatment after the federal supply is gone.
The Biden administration has stated it will confirm the end of the PHE 60 days before its end date. If the end of the PHE remains May 11, then that should be mid-March.
The Wisconsin Department of Health Services, or DHS, which administers Wisconsin’s Medicaid and BadgerCare Plus programs, is reviewing guidance from the Centers for Medicare & Medicaid Services, or CMS, to fully understand the extent of changes caused by the end of the PHE, Elizabeth Goodsitt, advanced communications specialist for DHS, said in an email. CMS is the national agency that oversees Medicaid programs, among others.
Those who want the most current information about Wisconsin’s unwinding of benefits can sign up for email updates.
While there have been many other benefits and resources connected to the pandemic, their unwinding is not directly tied to the PHE. Therefore, these changes, such as those affecting FoodShare benefits and the Medicaid/BadgerCare Plus renewal process, are on different timelines.
For people in the Greater Milwaukee area who have questions for a navigator, they can call or text 414-400-9489.
You also can go to coveringwi.org or wiscovered.com, where you can talk in real time with a navigator.
You can also call 2-1-1, a service that helps connect people to resources.
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